Dental implants seen as best replacement for old bridges

Dental implants seen as best replacement for old bridges

June 10, 2008 -- According to the American Academy of Implant Dentistry (AAID), aging dental bridges are difficult to floss, often decay, and require replacement with longer bridges. The AAID recommends replacing them with permanent dental implants.

"Many of us have had the same bridges in our mouths for 20 years or more. They were put in at a time when bridgework was considered to be the norm for replacing missing or compromised teeth," said Olivia Palmer, D.M.D., of Charleston, SC, an associate fellow of AAID and diplomate of the American Board of Oral Implantology.

Palmer explained that bridges generally fail after five to 10 years because patients have trouble flossing them. "Because these bridges link missing tooth spaces to adjacent teeth, many patients find it very difficult to floss the bridge," she said. "Therefore, root surfaces below and around bridgework often decay, if not kept meticulously clean by flossing. It is impossible to repair this marginal decay, so the entire bridge must be replaced."

For most patients, implants are a better treatment alternative because they preserve the bone of the jaw, can be flossed easily, do not decay, and function just like natural teeth, she added. Today, highly precise computer-guided dental implant surgery has made the procedure faster, highly predicable, long-lasting, and 97% successful.

Palmer advises anyone with one or more missing teeth who might consider having a first bridge inserted or replacing an old one to weigh the benefits of implants before getting treatment.

Lantis Laser's OCT system moves closer to commercialization

Lantis Laser's OCT system moves closer to commercialization

June 10, 2008 -- Lantis Laser has commenced the final development phase of its optical coherence tomography (OCT) Dental Imaging System.

The OCT Dental Imaging System consists of a small, handheld scanner that uses coherent light to capture hard or soft dental tissue in high-resolution cross-sectional images with up to 10 times the resolution of an x-ray. It can be used for early detection of tooth decay, caries around restorations at an early stage, gum disease, and more.

"The components of the OCT system that needed to be upgraded to meet the requirements of the fast scanning speed enabled by Axsun Technologies' swept source laser are being readied for integration into the OCT beta systems," said Stan Baron, president and CEO of Lantis in a company press release.

In April, Lantis announced a partnership with Axsun Technologies to develop its integrated microelectromechanical systems (MEMs) OCT engines.

The final developmental phase, the last stage before commercial rollout, also involves the design of the OCT system's mobile cart, to be undertaken by Eclipse Product Development.

"We expect to deploy the beta systems for clinical use in the July/August time frame," Baron said. A full commercial rollout is expected in 2009, with a targeted retail price of around $25,000.

Studies show less need for nerve blocks

Studies show less need for nerve blocks

June 10, 2008 -- Numb lips, a bitten cheek, slurred words. For years dentists haven't had much choice about causing such temporary discomforts with a nerve block in patients needing mandibular procedures. But recent research suggests an infiltration will suffice for most restorations.

Infiltrations, which target only the nerves of a specific tooth, work just fine in the maxilla. By contrast, the thick bone in the mandible keeps the anesthetic from getting to its target. So the standard recommendation is to use inferior alveolar nerve block (IANB) for any procedures done on the mandible -- much to the distress of many patients. "The thing that makes the patient fearful is that big injection," says Paul A. Moore, D.M.D., Ph.D., M.P.H., chair of dental anesthesiology at the University of Pittsburgh.

In addition to causing less numbness, using infiltration reduces the risk of adverse events associated with IANB, such as trismus, nonsurgical paresthesia, and hemorrhage in hemophiliacs. It's also simpler to master than some of the other alternatives to IANB, such as intraosseous and intraligamentary injections.

The new hope for mandibular infiltrations comes from experiments with articaine, a relatively new local anesthetic that has beaten lidocaine in recent comparative trials. In fact, at the International Association of Dental Research meeting in Toronto in July, Dr. Moore (previously paid as a research consultant for articaine-maker Septodont and other dental supply companies) will present data from a study showing that articaine is more effective than various formulations of lidocaine, prilocaine, mepivacaine, and bupivacaine.

In April 2006, researchers from the University of Newcastle upon Tyne (Journal of Endodontics, April 2006, Vol. 32:4, pp. 296-298) reported some of the first success anesthetizing lower teeth with an articaine infiltration. They were able to numb about 65% of mandibular first molars with articaine, compared to only 39% with lidocaine.

But the study left open the question of how these rates might compare in a matched group of patients getting IANB. Now the same group has reported on such a trial, in the May 2008 Journal of Endodontics (Vol. 34:5, pp. 514-518).

The researchers administered IANB using a solution of 2% lidocaine (1:80,000 epinephrine) to a group of 27 volunteers. Then they zapped the volunteers' first molars with an electronic pulp test. They considered subjects successfully anesthetized if they didn't feel anything at the electrical dose (80 A) on two consecutive tries. Fifteen of the volunteers (55.6%) achieved that level.

Later, the researchers performed another experiment on the same volunteers, giving them an infiltration of 4% articaine (1:100,000 epinephrine). This time 19 (70.4%) were successfully anesthetized. The difference between the success rate with IANB and rate with infiltration was not significant (p = 0.60).

Mall teeth whitening under scrutiny in New Mexico

Mall teeth whitening under scrutiny in New Mexico

June 9, 2008 -- The New Mexico Board of Dental Health Care believes that mall teeth-whitening businesses could be detrimental to public health, the Cibola County Beacon recently reported.

DrBicuspid.com recently highlighted some of the dental industry's concerns regarding this trend and what several states are doing to improve regulation of these facilities.

In New Mexico, tooth whitening is classified as a dental procedure that can only be performed by a licensed dentist or licensed dental hygienist under the supervision of a licensed dentist and after the patient has been examined by a licensed dentist.

"The Board of Dental Health Care has directed the Regulation and Licensing Department to take appropriate measures to ensure that all teeth-whitening services offered to the public are in full compliance with state law and federal regulation," reported the Beacon.

Toothbrushing causes bacteria to enter bloodstream

Toothbrushing causes bacteria to enter bloodstream

June 9, 2008 -- NEW YORK (Reuters Health), Jun 9 - Brushing one's teeth is nearly as likely as removing a tooth to temporarily cause bacteria to enter the bloodstream, according to a report in the journal Circulation. This finding is concerning because bacteria in the blood can lead to a rare but potentially serious heart problem called infective endocarditis, the infection of the heart valves and chambers.

The risk of infective endocarditis with toothbrushing relative to dental procedures is unknown, Dr. Peter B. Lockhart, from Carolinas Medical Center in Charlotte, NC, and colleagues note. Although tooth removal is among the most likely of dental procedures to cause bacteria to enter the blood, toothbrushing can disrupt a larger amount of gum tissue.

To investigate these effects, Lockhart's group randomly assigned 290 patients scheduled for tooth extraction to toothbrushing followed by tooth extraction; tooth extraction with an antibiotic given beforehand; and tooth extraction with inactive "placebo" beforehand. None of the patients required antibiotics to prevent infection based on current guidelines.

Blood samples were drawn prior to toothbrushing or tooth extraction, then at 1.5, 5, 20, 40, and 60 minutes after the beginning of the procedures. Blood samples were cultured for bacteria.

Of 98 types of bacteria found in the blood samples, 32 were considered to be potential causes of infective endocarditis. One or more of these 32 microbes were found in 23% of patients in the toothbrushing group, 33% of those in the extraction/antibiotic group, and 60% of those in the extraction-placebo group.

At the 60-minute blood draw, 5% of the extraction-placebo group and 2% of the brushing group still had potentially disease-causing bacteria in their blood.

These findings suggest that brushing poses a risk for bacteria in the blood similar to that of a dental extraction, the authors note, and that antibiotic treatment beforehand is only partially effective in preventing this.

Source: Circulation, June 17, 2008.

Last Updated: 2008-06-09 17:07:48 -0400 (Reuters Health)

Dentists vs. insurers: The road ahead

Dentists vs. insurers: The road ahead

November 5, 2007 -- One evening after attending the ADA's annual session in San Francisco, Karen Gustin was chatting with a dentist on the shuttle bus to her hotel. When he found out Gustin was vice president of marketing for insurer Ameritas Group Dental and Eye Care, he asked the person next to him if he could trade seats. "It was a joke -- sort of," says Gustin.

It shows just how tenuous -- even adversarial -- the relationship between dentists and insurance companies is. But as current healthcare trends show, you can't avoid dealing with insurance companies. Soon, you'll be even more involved with them.

Gustin and other insurance industry panelists described how the dentist/insurer relationship will evolve in "An Inside View of Dental Benefits" presentation at the ADA conference, underwritten by the National Association of Dental Plans (NADP).

All the panelists stressed insurers value good relationships with dentists. Besides having dedicated provider relations staff, insurers have advisory panels composed of dentists. "We take your comments very seriously," says Gene Sherman, a former dentist turned chief operating officer of Starmount Life Insurance Co.

Why should you care?

It's in your best interest to track where dental plans are going, says Jon Seltenheim, senior vice-president of operations at United Concordia Companies. "Dentists should want more people to enroll because coverage overcomes the cost barrier, making people more likely to visit the dentist and more often, and have more dental procedures."

In 2004, $81 billion was spent on dental care, and insurers paid half of that tab. The NADP predicts expenditures will more than double, to $167 billion, by 2015. That's partly due to more Americans getting dental benefits. (In 2006, it was 176 million, 57 percent of the U.S. population.) Half the people with dental benefits belong to a dental Preferred Provider Organization, and 23 percent belong to a dental indemnity plan, but the latter is pricey for both dentist and patient and will keep declining in popularity.

Many dentists wonder why maximum annual benefits have not increased in the past 25 years. That's due to employers, who provide 96 percent of Americans' dental coverage. According to Seltenheim, because medical costs keep going up, employers can only offer so much health insurance coverage. When push comes to shove, dental benefits are often the first to go. "The medical side is what drives their agenda because it's so difficult to control."

New products and target markets

The NADP estimates 41 percent of employers change their dental plan solely because of rates. They're also making more employees contribute more out-of-pocket costs.

Insurers are coming up with new options to keep both groups on board, such as increasing maximums based on a person's overall wellness. One approach: "Rollover maximums," which roll over a portion of an employee's annual maximum to future years as long as the employee visits the dentist at least once a year. Insurers are also expanding coverage to include implants and sealants for more age groups.

With the large-employer market saturated, dental insurers are going after small businesses and individuals, particularly the uninsured, part-timers, and retiring Boomers whose dental costs are not covered by Medicare. Individual-coverage plans have doubled from 12 to 23 in the past three years, and the AARP recently announced its own dental plan, sponsored by Delta Dental. That doesn't mean individual plans won't be less cost-sensitive, says Gustin. "It's like the Burger King slogan ‘Have it your way.' That's what people want, but they'll still be sensitive to costs as more of the premium costs shift to their pocket."

Get your money fast

Insurance companies are also emphasizing electronic claim filing (39 percent of all carriers currently offer it) which pays dentists three times faster than snail mail. And no, insurers are not sitting on claims longer than usual to earn interest. "States require us to pay within 14, 21, or 28 days," says Sherman. "What holds payment up is when we don't get all the necessary documentation."

A dumb reminder -- but one many dental offices don't follow -- is filling out all the required fields on forms and X-rays. Submitting duplicate X-rays is a good idea but don't send Xeroxed copies of radiographs. "They're too hard to read, and that will hold up your claim even longer," says Sherman.

Narratives provide good information -- but use them judiciously, Sherman adds. "They're helpful if there are extenuating circumstances but they can also create delays. They can't be auto-adjudicated, meaning the processing computer will spit out a claim with a narrative for a human to review it."

Insurers have partnered with National Electronic Attachment to create FastLook, a one-stop web site that lets dentists see all insurers' guidelines for claim filing. Go to http://www.nea-fast.com/ for details.

Future plans

The NADP is partnering with the ADA, dental societies, and dental insurers on several initiatives, including a tax break for dentists upgrading their office equipment, the inclusion of dental coverage in Health Savings Accounts, and a national campaign to promote oral health literacy.

The latter is especially important said panel members, as the media discovers that poor oral health is linked to higher risks for heart disease, stroke, and Alzheimer's. "The dentist is usually the first to identify systemic health problems--120 disease symptoms can be detected in the mouth alone," says Doyle Williams, a former dentist and chief dental officer for insurer DentaQuest. "We can rally around this point to increase people's access to dental care."

Insurers are looking to tweak coverage after assessing a person's risk status, says Williams. "It will no longer be one-size-fits all. It will be linked to one's health risks."

To increase oral health, Williams predicts insurers will soon cover the following:

Chlorhexide mouth rinse after scaling and root planning
Prescription-strength fluoride toothpaste for adults after periodontal surgery
Sealants for a greater range of age groups
More treatments for pregnant women and diabetics
Looking down the road a ways, the NADP is sponsoring scientific studies of vaccines and stem-cell research for further oral-based treatments. For now, its biggest push is creating assessment tools to identify people at highest risk, so they can get more frequent prophylaxis, scaling, and root planning.

These efforts can only pay off for dentists, says Williams. If insurers can identify these patients and get them treated earlier, they'll realize they need insurance. That means, says Williams, they'll be in your office more often and be getting the care they need.

Nonpracticing dentists now eligible for ADA membership

Nonpracticing dentists now eligible for ADA membership

November 2, 2007 -- Nonpracticing dentists or those with a dental degree lacking a U.S. license will be eligible to become members of the American Dental Association starting in January 2008, according to a resolution passed by The House of Delegates last month.

This move affects policymakers, government officials, dental industry representatives, dentists in the insurance industry, dentists in the corporate world, researchers, educators, and deans of dental schools.

"The ADA is committed to being the umbrella organization for the dental profession, and we can now offer a place in our organization to dentists who are valuable to and involved in the profession who in the past were not able to be dentist members," said Dr. Pamela Z. Baldassarre, chair of the ADA Council on Membership in a press release.

She used Rep. Mike Simpson (R-Idaho) as an example of a nonpracticing dentist who could be a valuable addition to the ADA.

"Congressman Simpson is a dentist by training but left dentistry for Washington and no longer holds a license. Dentists like Mike Simpson are involved in careers where there is no need to hold a license, yet they are influencing the way we practice dentistry," she said in the same release.

Nonpracticing members will pay half the dues, receive The Journal of the American Dental Association, can attend the ADA annual session, be elected to councils, but will not hold an ADA office.

The last new membership category approved by the ADA was the active life membership category, in 1991.